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Marce Society International Conference |
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| Abstracts 21 - 30
ABSTRACT 21
VALIDATION OF THE EPDS FOR CHINESE WOMEN IN AUSTALIA - DOES A PND RATE OF ZERO SEEM PLAUSIBLE?
Stephen
Matthey, Bryanne Barnett. Institution: Park House (Paediatric Mental Health Service), 13 Elizabeth Street, Liverpool 2170. Sydney NSW, Australia.Ph: (02) 9827 8011; Fax: (02) 9827 8010; email: pmhs@unsw.edu.au
The rate of PND across cultures has been found to be similar in many studies. Some researchers, however, have argued that those cultures which have close family networks and prescribed rituals around childbirth will have less, or even no, rates of PND. Our unit undertook to validate a Chinese version of the EPDS for use with women from this background in Australia. The methodology used was that prescribed in other centres, namely back translation of the EPDS, and the use of a structured diagnostic interview (DIS) to determine caseness at 6-8 weeks postpartum. In our sample of 120 women, none reported symptoms meeting criteria for major depression.
Clearly this could be due to either the fact that none of these women were depressed, or that those who were depressed did not admit to symptoms on the DIS. A discussion around this will be undertaken, which will highlight the difficulties inherent in cross-cultural research in this field. Experience from other work from on our unit with Arabic and Vietnamese mothers will also be discussed. Finally recommendations for the appropriate cut-off point on the EPDS for screening for PND in Chinese speaking women will be given.
ABSTRACT 22
VULNERABILITY FACT0RS IN WOMEN WITH A SEVERE POST-PARTUM ILLNESS: IMPLICATIONS FOR EARLY INTERVENTION.
Shelly
Colman, MSc, MA, MAPS, Clinical Psychologist, Mother-Baby Program Dept of Adult Psychiatry, Monash Medical Centre, Clayton 3168 Victoria Tel: 9594 1459 Fax: 9594 1408 - Karen Curnow, MPsych, MAPS Psychologist/Research Officer, Mother-Baby Program Mary Terzic, Mpsych Psychologist/Research Officer, Mother-Baby Program
The Mother-Baby Program (MBP) at Monash Medical Centre is a specialist six bed inpatient program that provides multidisciplinary assessment and treatment of women who experience a severe mental illness in the post-partum period and also admits their infants. This paper reports the significant findings of a retrospective analysis of 100 MBP patient files spanning a 20 month period and focuses on the personal, psychiatric, familial and social characteristics of the women admitted. There were a number of "vulnerability factors" that were strongly represented in this sample of MBP women that have been shown in the literature to be associated with the development of post-partum mental illness. These vulnerability factors included a personal history of mental illness, a family history of mental illness, a history of childhood sexual, physical or emotional abuse and separation from family of origin in early life. A significant number of women were identified to be experiencing several concurrent social and personal stressors, including, most commonly, limited social support, financial, housing and relationship problems. The presence of these vulnerability factors in the present study was also significantly associated with a greater level of service utilization indicated by several measures including a greater length of admission to the MBP. Importantly, the presence of such vulnerability factors in this sample of women has implications for the provision of psychiatric and social support services both during pregnancy and immediately following childbirth. These vulnerability factors can be used as markers for the early identification of women who are at a high risk for developing post-partum illnesses, with the aim of reducing or preventing symptom escalation and the need for longer and more intensive post-natal treatment.
ABSTRACT 23
DISENTANGLING THE RELATIONSHIPS BETEEN INFANT TEMPERAMENT, POSTNATAL DEPRESSION AND TODDLER BEHAVIOUR PROBLEMS: PRELIMINARY RESULTS FROM A PROSPECTIVE STUDY
McMahon,
C1, Kowalenko, N, Barnett, B, Don, N, & Tennant, C. Research Fellow, Department of Psychological Medicine, Level 5, Block 4, Royal North Shore Hospital, St Leonards, 2065. Ph. (02) 9926 7786, Fax (02) 9926 7730, email: cmcmahon@med.usyd.edu.au
A number of studies have reported relationships between difficult infant temperament and postnatal depression, and both maternal depression and infant temperament are reported to be associated with toddler behaviour problems. This paper aims to disentangle the relationships between postnatal depression, maternal reports of infant temperament and subsequent infant behaviour problems.
Subjects 45 mothers and infants admitted to Tresillian Family Care Centres have been followed up until 12-15 months of age. Our pilot study has demonstrated that 50% of residential care mothers have postnatal depression and also that "infant difficultness" is common and yet uniformly distributed among both the depressed and non-depressed mothers.
Method Depressive symptoms were assessed using the EPDS (3-4 months) and the CES-D (12 months). Mothers were interviewed on both occasions using the CIDI to assess whether they met DSM IV criteria for a major depressive episode. Infant temperament was rated by mothers and fathers at both 4 and 12 months using the Short Temperament Scale for Infants. Toddler behaviour problems were assessed at 12 months using the Behaviour Screening Questionnaire (BSQ) which assesses self-regulatory behaviours (feeding and sleeping), play, and response to other infants and children. In addition, 35 of the infants have been assessed at 15 months using the Bayley Behaviour Rating Scales (BBRS) which assess attention/arousal, social orientation and engagement, emotional regulation and motor quality during developmental testing.
Results Correlations between infant temperament at 4 and 12 months will be explored and descriptive statistics will be presented comparing this group of toddlers with normative data for both the BSQ and the BBRS. Finally, the relative contributions of infant temperament, maternal depression and the interaction between them in explaining toddler behaviour problems will be explored using dichotomous logistic regression and multiple regression. Clinical implications of the findings will be discussed.
ABSTRACT 24POSTNATAL DEPRESSION, PARENT-INFANT RELATIONSHIP AND INTERVENTION
J. Milgrom*
and L.M. Negri** Department of Clinical Psychology, Austin & Repatriation Medical Centre, Banksia Street, Heidelberg West, Victoria, 3081. *Austin & Repatriation Medical Centre & ** La Trobe University
In our initial study, 38 mothers with severe postnatal depression (PND) were compared to 46 non-depressed controls over time. Depressed mothers at three months postpartum were found to be less responsive in face-to-face interaction with their infants whom they rated as less reinforcing, less acceptable, less adaptable, more moody and more demanding. PND mothers rated themselves as less competent, less emotionally attached to their child and less healthy. Social and relationship difficulties with their spouse were evident. These differences persisted over a twelve month period, even though the level of depression decreased. In a follow-up study 24 months later, women who had suffered from postnatal depression remained differentiated from control women in terms of their mood, marital relationship and perception of their children. They also rated their children as significantly more symptomatic on behavioural checklists.
In our current study, 60 women have been offered early intervention for their depression at around three months postpartum. Preliminary findings suggest a limited improvement in parent-infant relationships resulting from programs which target depressed mood only, without targeting the mother-infant interaction, despite significant amelioration of depressive states. The relationship between maternal depression and parent-infant attachment is discussed in the context of a proposed model.
ABSTRACT 25
ALL OF US TOGETHERAlison
Vile Program Facilitator Dawn
Miller Visiting Rural Maternal and Child Health Nurse
Young
Families and a Home Visiting Nursing Service in Rural Victoria
Maternal
and Child Health Service - 'New Initiatives' Program Towong
Shire Council PO Box 55 Tallangatta Vic 3700
The Visiting Rural Maternal and Child Health Nursing Service is providing additional parenting support for rural families with pre-school children in North East Victoria. The service, totally funded by the Victorian Government Department of Human Services 'New Initiatives' program, is additional and complementary to the established Maternal and Child Health Service.
Consultations are in the client's home, the time and number of visits are negotiated with the parents according to their needs. Referral from a health provider is not necessary. The service provides antenatal information and postnatal domiciliary care. The first few months following the infant's birth may be particularly stressful when the family is adjusting to the new family member. Extra support is offered during this time. Traditionally, fathers in the rural areas frequently perceive the Maternal and Child Health Centres as 'mother' oriented and that the care of the young infant is the responsibility of the mother. Fathers are encouraged to be in attendance during the visits by the nurse and to give emotional and practical support to the mother. Since the program commenced there has been a significant increase in fathers acquiring parenting knowledge and skills.
Anecdotal evidence supports our belief that this visiting service by educating, empowering and supporting both parents, sanctioning the involvement of fathers with their children's care and development are contributing factors to family health and well being both now and in the future.
Key Words Rural families, home visiting, parenting, fathers.
ABSTRACT 26
A MULTI-FACTORIAL ANALYSIS OF POST-NATAL DEPRESSION
E.P.
MILLS
INTRODUCTION: This ongoing study investigates some factors that may distinguish women vulnerable to PND. By comparing a depressed sample of mothers, with a non-depressed sample, it is hoped to highlight some of the distinguishing features.
METHOD: The data was derived from structured PND-Assessment Interview Questionnaires, involving 300 women, who were referred for inclusion in Postnatal Depression Support & Therapy Groups. Answers were recorded by the interviewer, and the women, in addition, completed the EPDS and a Symptoms & Feeling Checklist. The Control Group comprised mothers who attended Well-Baby Clinics, and who were invited to "take part in a research project". No identifying information was required. The Control Group completed the same Questionnaire and scoring instruments. The Questionnaire covers demographics, obstetric data, psychopathology of the subjects and their biological families, family relationships including effects of PND, stress factors, social support systems, infant-related perceptions and details, personality factors, plus major symptoms and time of onset of the depression, where applicable. The data has been submitted for statistical analysis.
RESULTS: The data is, at this time, undergoing statistical analysis, and preliminary findings (frequency tables, correlations and factor analyses) suggest considerable differences may exist between the two groups.
CONCLUSIONS: If there is a typical profile of women who are predisposed to developing PND, it is important that the women, themselves, and health professionals take cognisance of this. The woman is seen at the centre of a "bombardment" of outside influences and internal needs. . 00000 Past losses, bereavement, experience of life transitions, family traditions, expectations and role changes, all impact on her. In the researcher's opinion, the origins of PND are multi-dimensional, and an increased understanding of some of the dimensions may lead us to some answers as to why PND may form part of the tapestry of a woman's life.
ABSTRACT 27
MOTHER-INFANT THERAPY GROUP
Mary Morgan (Occ. Th) and Natasha Figon (Psych) Professional Affiliations: Occupational Therapist and Psychologist
Address:
Mary Morgan - Jade House, 130 Nelson Street, Fairfield Height 2165, Phone (02) 9754 2655 Fax (02) 9754 2644 Natasha
Figon - Karitane Residential Unit, PO Box 241, Villawood, NSW, 2163 Phone (02) 9794 1800 Fax (02) 9794 1858
Murray & Cooper (1997) concluded that "the quality of the early maternal environment does appear to be of predictive significance" with regard to the course of development in infants.
A pilot Mother-Infant Therapy Group will be described. Four to six mothers and their infants participated over the course of eight weeks. Mothers and infants were recruited from a mothercraft residential unit. Mothers were invited to attend on the basis of high Edinburgh Postnatal Depression Scale scores, demonstrating some relationship difficulties with their infant as well as dyads where infants were particularly unsettled. There were two therapists, and the group utilised psychodynamic and attachment principles. They provided observations and comments on interaction occurring within the group. The aim of the group was to enhance the mother-infant relationship. Evaluation included qualitative and quantitative measures. Themes emerging from both mothers and infants will be described. Maternal empathy and the importance of attunement will be illustrated using clinical material. A further aim is to determine the direction and need for future Mother-Infant Therapy Groups.
ABSTRACT 28
FUNCTIONAL STATUS AT 24 WEEKS POSTPARTUM OF WOMEN WITH POSTNATAL DEPRESSION
Department of Psychological Medicine, University of Sydney, Nepean Hospital. Stuart
J. Johnstone, Philip M. Boyce, Anthea R. Hickey, Allen D. Morris-Yates,
Meredith G. Harris, and Trish Strachan.
Department of Psychological Medicine, Clinical Sciences Building, Nepean Hospital, P.O. Box 63, Penrith NSW 2751. Phone: 02 4724 2435, Facsimile: 02 4724 3343, Email: johnsts@wahs.health.nsw.gov.au
This study examined the effect of postnatal depression, age, and parity on eight indicators of functional status, as assessed by the SF-36 self-report questionnaire, at 24 weeks postpartum, with a prospective cohort design. 424 postpartum women completed the SF-36, a self-report questionnaire designed to assess functioning and well-being. 54 women (12.7%) were classified as depressed (i.e. scored >12 on the Edinburgh Postnatal Depression Scale) at eight weeks postpartum. At twenty four weeks postpartum, women with depression were impaired on five of eight SF-36 dimensions (Role Limitations due to Physical and Emotional Problems, Social Functioning, Mental health, and Vitality) while women not suffering from depression were impaired in two dimensions only (Role Limitations due to Emotional Problems and Vitality) in comparison to age-appropriate Australian normative data. Depressed and non-depressed postpartum women differed from each other on six SF-36 dimensions (Role Limitations due to Physical and Emotional Problems, Social Functioning, Bodily Pain, Mental Health, and Vitality). Role Limitations due to Physical Problems were more impaired in first-time than multiparous mothers who were depressed, with parity difference for non-depressed women. It is concluded that some declines in functional status are associated with the postpartum period generally, but postnatal depression detrimentally effects many other aspects of the postpartum women's health.
ABSTRACT 29
THE COURSE OF MATERNAL DEPRESSION IN THE FIRST POSTPARTUM YEAR AND THE IMPACT OF PATERNAL MENTAL HEALTH AND WELL BEING
Kowalenko
N., McMahon C., Barnett B., Don N. and Tennant C. Clinical
Director, Child and Adolescent Psychiatry, Block 4, Level 2. Royal
North Shore Hospital Ph: (02) 9926 8905, Fax: (02) 9906 8136 e-mail: nkowa@doh.health.nsw.gov.au
This paper reports preliminary results of a larger prospective study examining the course and recurrence of postnatal depression and dysphoria in a group of 45 first time mothers admitted to Tresillian Family Care Centres (as inpatients) in Sydney, NSW. Paternal mental health and well-being will also be reported.
These results will address issues related to the categorial diagnosis of major depression vs dysphoria, and also the prevalence of : recurrent vs de novo onset of affective disturbance and transient vs persistent mood disturbance in the first postnatal year. In the long term, the study will be able to address how these different patterns of maternal depression impact on child outcomes.
Method
Mothers were screened on admission with the EPDS, subsequently interviewed at 4 months and again at 12 months using a diagnostic interview for current and lifetime history of depression (CIDI). Symptoms of depression were assessed at 12 months with the CES-D for both mothers and fathers. Self-report data on anxiety state and marital adjustment for both parents will also be presented.
Interview data on the use of medication history of counselling, previous hospitalisations and suicide attempts will also be reported
Results
Relationships between episodes of maternal depression in the first four months after childbirth, past history, recurrence and persistence of depression will be reported. Associations with paternal mental health will also be presented.
ABSTRACT 30
SURVIVING BEYOND THE BIRTH
Wendy
Lauder, Registered Nurse, Registered Psychiatric Nurse, Diploma of Holistic
Healing. An innovative program between the Women's Mental Health Program (Division of Psychiatry) and Maternity Services (The Bendigo Hospital). This program has a strong preventative and early intervention focus for women in the post partum period.
Offered on a weekly basis as part of the educative program for new mothers this ¾ hours session focuses on:
The second part of the program is to offer training to maternity ward staff and maternal and child health nurses in rural/remote areas of the Loddon Southern Mallee Region. This training is aimed to skill up staff so that they can incorporate these elements into their own education sessions offered to new mothers.
This Training package can be used as a model within any maternity service or maternal and child health centre to compliment existing education program for new mothers.
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